Important Prognostic Factor For Survival Research Articles

Age, Gleason Score, and PSA are important prognostic factors for survival in metastatic castration-resistant prostate cancer. Results of The Uroncor Group (Uro-Oncological Tumors) of the Spanish Society of Radiation Oncology (SEOR).

The treatment of metastatic castration-resistant prostate cancer (mCRPC) has changed significantly in recent years. Inhibitors of androgen receptors have shown especially significant benefits in overall (OS) and progression-free survival (PFS), with a good toxicity profile. Treatment selection depends on the patient's individual clinical, radiological, and biological characteristics. To describe treatment outcomes (efficacy, toxicity) in a cohort of patients with mCRPC in Spain. Multicenter, retrospective study of patients with mCRPC included in a database of the Urological Tumour Working Group (URONCOR) of the Spanish Society of Radiation Oncology (SEOR). Metastatic CRPC was defined according to the prostate cancer working group 3 (PCWG3) criteria. The Kaplan-Meier technique was used to evaluate OS and the Common Terminology Criteria for Adverse Events (CTCAE, v.4.0) were used to assess toxicity. Univariate and multivariate Cox regression analyses were performed to identify the factors significantly associated with OS. A total of 314 patients from 17 hospitals in Spain diagnosed with mCRPC between June 2010 and September 2017 were included in this study. Mean age at diagnosis was 68years (range 45-89). At a median follow-up of 35months, OS at 1, 3, and 5years were 92%, 38%, and 28%, respectively. Grades 1-2 and grade 3 toxicity rates were, respectively, 68% and 19%. No grade 4 toxicities were observed. On the multivariate analysis, the following factors were significantly associated with OS: age (hazard ratio [HR] 0.42, p = 0.010), PSA value at diagnosis of mCRPC (HR 0.55, p = 0.008), and Gleason score (HR 0.61, p = 0.009). Age, Gleason score, and PSA at diagnosis of mCRPC are independently associated with overall survival in patients with mCRPC. The efficacy and toxicity outcomes in this patient cohort treated in radiation oncology departments in Spain are consistent with previous reports.

Right diaphragmatic peritonectomy for ovarian carcinomatosis in 10 steps

Residual tumor after cytoreductive surgery has been demonstrated to be the most important prognostic factor of survival in patients with advanced ovarian cancer.[1][1] Extended peritonectomy procedures following Sugarbaker principles are...

Circulating tumor cells prior to initial treatment is an important prognostic factor of survival in non-small cell lung cancer: a meta-analysis and system review

BackgroundOur study aimed to verify the prognostic value of circulating tumor cells (CTCs) prior to initial treatment on survival of non-small cell lung cancer (NSCLC) by using meta-analysis and system review of published studies.Materials and methodsThe PubMed, EMBASE and Cochrane Library were searched, respectively, to identify all studies that addressed the issues of CTCs prior to initial treatment and progression-free survival (PFS) and overall survival (OS). Finally, ten citations were included for analysis and assessment of publication bias by using review manager 5.3 statistical software and STATA 15.0.ResultsRandomized model analyzing multivariate Cox Proportional Hazards Regression indicated that higher abundance of CTCs significantly predicts poorer prognosis of lung cancer cases basing both on PFS (Z = 2.31, P = 0.02) and OS of advanced cases (Z = 2.44, P = 0.01), and systematic study aslo indicated the similar results.ConclusionHigh CTCs prior to initial treatment can predict shorter PFS and OS in NSCLC, and further studies are warranted in the future.

Better outcome for parotid versus neck metastasis of head and neck cutaneous squamous cell carcinoma: a new report on reemerging data

IntroductionRegional metastases of cutaneous head and neck squamous cell carcinoma occur in approximately 5 % of cases, being the most important prognostic factor in survival, currently with no distinction between parotid and neck metastasis. ObjectiveThe purpose of this study was to evaluate the prognostic features among patients with head and neck cutaneous squamous cell carcinoma exhibiting regional metastasis. MethodsA retrospective analysis of patients with cutaneous squamous cell carcinoma who underwent parotidectomy and/or neck dissection from 2011 to 2018 at a single institution tertiary center was performed. Patient demographics, clinical, surgical and pathological information, adjuvant treatments, and outcome at last follow-up were collected. Outcomes included disease recurrence and death due to the disease. Prognostic value of clinic pathological features associated with disease-specific survival was obtained. ResultsThirty-eight cases of head and neck cutaneous squamous cell carcinoma with parotid and/or neck metastasis were identified. Overall, 18 (47.3 %) patients showed parotid metastasis alone, 12 (31.5 %) exhibited neck metastasis alone and 8 (21.0 %) had both. A primary tumor in the parotid zone (Hazard Ratio ‒ HR = 5.53; p = 0.02) was associated with improved disease-specific survival. Poorer disease-specific survival was observed in patients with higher primary tumor diameter (HR = 1.54; p = 0.002), higher depth of invasion (HR = 2.89; p = 0.02), invasion beyond the subcutaneous fat (HR = 5.05; p = 0.002), neck metastasis at first presentation (HR = 8.74; p < 0.001), number of positive lymph nodes (HR = 1.25; p = 0.004), and higher TNM stages (HR = 7.13; p = 0.009). Patients presenting with isolated parotid metastasis during all follow-ups had better disease-specific survival than those with neck metastasis or both (HR = 3.12; p = 0.02). ConclusionHead and neck cutaneous squamous cell carcinoma with parotid lymph node metastasis demonstrated better outcomes than cases with neck metastasis.

Depth of Pre-Treatment Immunoparesis Is an Important Prognostic Factor for Survival in Relapsed Multiple Myeloma

Background: Suppression of uninvolved immunoglobulins [Ig], or immunoparesis, is associated with an inferior progression-free survival [PFS] and overall survival [OS] in patients with newly diagnosed multiple myeloma [MM]. However, immunoparesis in relapsed MM can be either due to the underlying disease or prior anti-myeloma therapy or both. Data on characterization and prognostic impact of immunoparesis in relapsed MM is lacking in the era of proteasome inhibitors and immunomodulatory drugs. We hypothesized that immunoparesis in relapsed MM is a marker of high tumor burden or adverse biology and is associated with an inferior post-relapse survival. Method: We evaluated all MM patients diagnosed between 1/1/2008 and 12/31/2015 at the Cleveland Clinic and followed until 05/31/2019. Key inclusion criteria were patients experiencing first relapse requiring an additional line of therapy and available data on pre-therapy immunoglobulin levels. Both Qualitative and Quantitative immunoparesis were defined using the method described earlier [Muchtar et al. Leukemia. (2017) 31. 92-99]. Qualitative immunoparesis was categorized as No [preserved uninvolved Igs], Partial [suppression of at least one but not all uninvolved Igs], or Full [suppression of all uninvolved Igs]. For quantitative immunoparesis, the average relative difference [ARD] from the corresponding lower limit of normal was calculated. Recursive partitioning analysis was performed with a log-rank splitting method to identify an optimal ARD cut-point for OS. The primary endpoints were PFS and OS from first relapse, which were estimated using Kaplan-Meier method and groups were compared with log-rank test. Cox proportional hazards analysis was used to identify univariable and multivariable prognostic factors for PFS and OS. Results: A total of 527 patients with newly diagnosed MM were evaluated, among which, 258 [49%] experienced first relapse and formed the study cohort. The median age at first relapse was 64 years, with a median of 24.5 months from diagnosis to first relapse. Front-line therapy included bortezomib in 77% and lenalidomide in 76% of patients. A total of 217 [85%] patients relapsed on therapy, the most common being maintenance with PI or IMiD [+/- steroid]. Biochemical-only relapse happened in 56% of patients. The distribution of qualitative immunoparesis at first relapse was: No [n=24; 9%], Partial [n=76; 30%], or Full [n=158; 61%]. For quantitative immunoparesis, the median ARD was -39% [range, -92 to 241], with higher negative values indicating deeper immunoparesis. The median ARD was +67%, +15%, and -58% in No, Partial, Full immunoparesis subgroups respectively [P&lt;0.001]. At a median follow-up of 34 months from first relapse, 2-year PFS in No, Partial, and Full immunoparesis subgroup was 36%, 25%, and 20% respectively [P=0.008]. The 3-year OS in respective subgroups was 60%, 42%, and 40% [P=0.09]. For quantitative immunoparesis, the optimal ARD cut-point for OS was -47%, which was rounded to -50% for ease of interpretation. Hence, patients were divided into 2 groups: &gt;-50% [n=155; 60%] and ≤-50% [n=103; 40%]. Higher immunoparesis depth [ARD≤-50%] at first relapse was significantly associated with the following: abnormal karyotype at diagnosis, deeper immunoparesis at diagnosis, less than a very good partial response [VGPR] in first remission, ≤12 months from diagnosis to first relapse, high serum free light chain ratio, β-2 microglobulin, and lactate dehydrogenase at first relapse, and low hemoglobin at first relapse. Notably, relapse on therapy versus on observation was not associated with the depth of immunoparesis at first relapse. The 2-year PFS in &gt;-50% and ≤-50% subgroup was 27% and 17% respectively [P&lt;0.001], with respective 3-year OS of 47% and 36% [P=0.007]. In multivariable analysis [MVA] assessing qualitative immunoparesis, immunoparesis remained prognostic for PFS but not OS. In MVA assessing quantitative immunoparesis, it remained prognostic for both PFS and OS. The Kaplan-Meier curves for PFS and OS with qualitative and quantitative immunoparesis are shown in Figure I. Conclusion: Depth of immunoparesis at first relapse is an additional prognostic factor for post-relapse survival in MM in the era of novel agents and continuous therapy. The clinical implication of immunoparesis as a prognostic factor is further amplified by the widespread availability of immunoglobulin measurement. Figure 1 Disclosures Valent: Amgen corporation: Speakers Bureau; Celgene corporation: Speakers Bureau; Takeda pharmaceuticals: Speakers Bureau. Anwer:Seattle Genetics: Membership on an entity's Board of Directors or advisory committees; In-Cyte: Speakers Bureau.

199P - Outcome of non-metastatic male breast cancer: 222 patients

BackgroundThere are limited data for Male breast carcinoma(MBC) in the era of adjuvant taxanes and trastuzumab. We have previously reported outcome of non-metastatic 113 patients(pts) with MBC. We aimed to evaluate outcome of the changing adjuvant systemic treatment practices and survival in operable MBC. MethodsThe medical records of 261 MBC pts followed between 1986-2018 at 8 cancer center were reviewed retrospectively. 222 patients had non-metastatic MBC at the time of diagnosis were included in current study. ResultsMedian age was 61(29-91) years. Median follow-up 55(1-275)months(mths). %91 of the pts had invasive ductal carcinoma. Also, 30.6% had T3-4 tumors. About half of study group had axillary lymph node-positive tumors. The proportion of positivity of ER, PgR and HER2 status were % 82.5, 73.1 and %18.4. Ten pts had TN MBC. 55 of pts had at least one comorbid chronic illness. 83.9 % of pts had modified radical mastectomy(MRM). 79.9% of pts received adjuvant radiotherapy. Adjuvan hormonotherapy were advised for %78.8, whereas adjuvant chemotherapy(CT) for 71.2 % of the pts(CMF 10.6%, adjuvant trastuzumab %7.5 and antracycline and/or taxane based 81.9% ). 9 HER2-positive pts had no adjuvant CT. Locoregional and/or distant recurrence rate was 36.9%. 77 (34.5%) pts died during follow-up. 52 of them died from metastatic breast cancer. 5-year disease-free survival(DFS) was found to be 66.6 % whereas overall survival(OS) was 73.5 %. Patients with stage I/II tumor were significantly longer DFS as compared to pts had stage III MBC( median not reached vs 78 mths, P<.001). Also, the latter group of pts had worse OS than the first group ( median 103 vs 153 mths, P=.030). Median DFS for pts had MRM was significantly better than patients had limited surgery (one-third of those pts had no axillary dissection)(118 vs 57 mths, P=.002). Two HER2-positive pts treated with adjuvant trastuzumab containing regimen had breast cancer recurrence(n=11) and alive whereas 9 of 19 pts treated other chemotherapy regimen (All but 2 anthracycline and/or taxane based) had experienced the disease relapse and 7 of them died from MBC. ConclusionsAlthough the adjuvant use of anthracyclines /taxanes and trastuzumab for MBC have increased in the last 10 years, stage at diagnosis is still important prognostic factor for survival in MBC. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

P1.06-05 Clinical Features and Outcomes of Recurrence After Pleurectomy/Decortication for Malignant Pleural Mesothelioma

Malignant pleural mesothelioma (MPM) is an aggressive tumor while most patients experience recurrence after multimodality treatment. However, few clinical studies have been conducted to evaluate the recurrence pattern and survival after Pleurectomy/decortication (P/D) for MPM. We reviewed the patients who registered in the prospective MPM database of our hospital surgery program between September 2012 and December 2017. Eligibility criteria were age ≤80 years, histological subtype on pleural biopsy was epithelioid, clinical stage T1-3N0-1M0 (8th edition), an Eastern Cooperative Oncology Group performance status of 0-1, no major comorbidity. Neoadjuvant chemotherapy (NAC) consisted of pemetrexed followed by cisplatin was performed in all patients who met previously mentioned inclusion criteria. After NAC for three cycles, curative-intent surgery was planned in patients who showed no apparent tumor progression. In our hospital, P/D was introduced in September 2012, and since then P/D was main operative method for MPM. After P/D, If the patients keep good general condition, the patients underwent adjuvant chemotherapy consisted of pemetrexed follow by cisplatin. The subjects were 90 patients who underwent NAC followed by P/D from September 2012 to December 2017. Survival and recurrence were calculated by the Kaplan-Meier method using the log rank test. Clinical factors related to survival after recurrence was assed by a multivariable analysis using Cox proportional hazards model. Between September 2012 and December 2017, 140 consecutive patients were eligible for multimodality treatment. All patients completed neoadjuvant chemotherapy. Of these, 112 patients proceeded to surgery, and the remaining 28 patients didn’t because of progressive disease (N= 20) or because they refused to provide consent (N= 8). Of 112 patients who proceeded to surgery, 12 patients underwent extrapleural pneumonectomy, 10 patients underwent exploratory thoracotomy. Finally, 90 patients underwent P/D. Of 90 patients, 65 patients (72.2%) completed multimodality treatment. The 1-year and 3-year overall survival rates after diagnosis were 93.3% and 65.3%, respectively. A recurrence developed in 57 (63.3%). The median time to recurrence was 19.0 months. 1-year and 3-year recurrence free survival were 69.7% and 34.0%, respectively. In the initial recurrence, local recurrence only was developed in 39 patients (68.4%), distant recurrence only in 6 patients (10.5%), and both local and distant recurrence in 12 patients (21.1%). 1-year survival rates after recurrence was 59.5%. 43 patients (75.4%) received a treatment for recurrence. On multivariable analysis, treatment for recurrence (hazard ratio, 0.16; 95% confidence interval, 0.06–0.41: P <0.0001) and disease-free interval greater than 12 months (hazard ratio, 0.34; 95% confidence interval, 0.14 –0.79; P = 0.01) were identified as independently significant prognostic factors of survival after recurrence. The local recurrence remain the most frequent pattern of recurrence after P/D. Most of patients who had recurrence after P/D enabled treatment for recurrence. Treatment for recurrence and disease-free interval greater than 12 months are important prognostic factors of survival after recurrence.

Obesity Paradox in Chronic Liver Diseases: Product of Bias or a Real Thing?

In recent years, evidence supporting the theory of obesity paradox has increased, showing that obese/overweight people with prevalent chronic diseases experience lower mortality compared with patients of normal weight. So far, evidence is most comprehensive in cardiovascular and chronic renal diseases; however, published studies are prone to many biases, enabling us to reach a definite conclusion. Available data in chronic liver disease is scarce and ambiguous. Obesity is traditionally associated with nonalcoholic fatty liver disease and steatosis in viral hepatitis and as such one would not expect the obesity paradox to be a real possibility in liver disease. Yet, there seem to be new data indicating the opposite – the obesity paradox exists in severe and end-stage liver cirrhosis, which could be attributed to a better lean mass in patients with higher body mass index, meaning that sarcopenia, as one of the most important prognostic factors of survival, is less likely to be present. Nonetheless, the problem of various methodological problems addressing the association between body weight and mortality, which is present both in liver disease and other chronic diseases, are preventing us from attaining an unanimous conclusion. Still, we should be aware that the obesity paradox might be true, especially in severe and end-stage illness. This suggests focusing our efforts toward preserving or building up fat-free mass and decreasing inflammatory activity responsible for catabolism and sarcopenia, and implying that the underlaying cause should be treated.

JAAD Game Changers∗: High-risk cutaneous squamous cell carcinoma and the emerging role of sentinel lymph node biopsy: A literature review

Capsule Summary•Most patients with squamous cell carcinoma have a favorable prognosis; however, high-risk squamous cell carcinoma is associated with aggressive clinical behavior and higher morbidity/mortality.•The extent of regional nodal involvement is an important prognostic factor for survival.•Sentinel lymph node biopsy may identify occult nodal metastases in patients at risk.How did this article change the practice of dermatology?Cutaneous SCC (cSCC) is the second most common skin cancer, and some of these patients are at risk for nodal metastasis and death. This article demonstrated that there is some evidence that supports considering sentinel lymph node biopsy for staging, prognostication, and therapeutic planning in cSCC classified as American Joint Committee on Cancer–7th Edition T2 larger than 2 cm in diameter or T2b in the alternative staging system.1 Patients with other high-risk factors. such as recurrent cSCC, and patients who are immunosuppressed should be included in trials evaluating the utility of sentinel lymph node biopsy in cSCC.

Lack of Survival Benefit of Para-Aortic Lymphadenectomy in Advanced Cervical Cancer

Introduction: The presence of positive para-aortic lymph nodes in advanced cervical cancer remains the most important prognostic factor for survival and also defines the treatment. Our aim was to define the influence of staging para-aortic lymphadenectomy in patients’ survival. Material and Methods: The medical records of 74 patients with advanced cervical cancer (FIGO IIB-IVA) were reviewed. In 31 patients (41.9%), the assessment of lymph nodes was performed with imaging test (group 1) and in 43 (58.1%) within a surgical staging para-aortic lymphadenectomy (group 2). We compared both groups according to stage of disease, treatment, progression-free survival (PFS), and overall survival (OS). Results: The extended-field radiotherapy was performed in 44.2 and 19.4% of patients in surgical and imaging staging group, respectively (p = 0.045). The disease-free survival rate was 17.4 ± 17.4 months in group 1 and 14.4 ± 12.6 months in group 2 (p = 0.456). No differences in OS were found between these 2 groups (p = 0.676). Conclusions: Despite the higher diagnostic accuracy of surgical staging and the higher number of patient who received extended field radiotherapy, we did not find differences between the overall and PFS rates in both the studied groups. Further prospective study on a higher number of patients would be necessary.

Neoadjuvant chemotherapy and interval debulking surgery for advanced ovarian cancer, an alternative with multiple advantages.

Ovarian cancer, which is mostly diagnosed in advanced stages, is a disease with high mortality among women. Until now, no screening strategies have been accepted and are currently under study because although they help in the diagnosis at early stages, they do not increase survival. The gold standard treatment for advanced ovarian cancer is based on primary debulking surgery (PDS) follow by adjuvant chemotherapy (ACT) with paclitaxel and carboplatin. Recently, treatment alternatives have been proposed: neoadjuvant chemotherapy (NAC) with interval debulking surgery (IDS). This approach has been controversial due to the lack of clinical data on the validity as a safe and successful procedure and because of the high morbidity and mortality associated to this disease. The most important prognostic factor for survival is no residual tumor after surgery; despite of this, numerous tumors do not fulfill the criteria for performing a PDS and associated morbidity is unacceptable high. Based on selected clinical features, NAC-IDS could be a reasonable alternative to those patients with reversible contraindications to primary surgery with the only objective of improving survival and quality of life (QOL). Although, several papers have reported that NAC could induce ACT resistance, neither randomized controlled trials nor meta-analyses have demonstrated this fact. The true is that more advantages have been reported: NAC groups trend toward higher QOL and lower rates of postoperative adverse events. This has been confirmed by two randomized clinical trials, but further studies are needed to support the role of NAC. Meanwhile, patients should receive the best opportunities and the best option for treating this type of cancer.

The Significance of Extent of Extracapsular Extension in Patients with T1-2 and N1 Breast Cancer.

The prognostic importance of extracapsular extension (ECE) in breast cancer is not yet clear, especially in patients with pathological T1-2 and N1 (pT1-2N1) disease. We aimed to investigate whether the extent of ECE was an independent prognostic factor for survival outcomes in patients with pT1-2N1 breast cancer. A total number of 131 patients with pT1-2N1 breast cancer treated between 2009 and 2015 were retrospectively evaluated. A single pathologist re-analyzed the histologic examples of all cases. The extent of ECE was graded from 0 to 4. There was a significant correlation between the number of lymph nodes involved and ECE grade (p=0.004). According to the univariate analysis, lymphovascular invasion (LVI) and ECE grade were the significant prognostic factors for overall survival (OS); age, number of metastatic lymph nodes, menopausal status, and ECE grade were the prognostic factors for disease-free survival (DFS). With a median follow-up of 46 months, grade 3-4 ECE seems to be notably associated with a shorter OS and DFS in multivariate analysis. The mean OS was 85 months for the patients with grade 0-2 ECE vs 75 months for the patients with grade 3-4 ECE (p=0.003). The mean DFS was 83 months for the patients with grade 0-3 ECE vs 68 months for the patients with grade 4 ECE (p=<0.0001). This research has shown that the extent of ECE is an important prognostic factor for survival in pT1-2N1 breast cancer patients and grade 3-4 ECE seems to be notably associated with a shorter OS and DFS.

Prognostic factors of survival in HIV/HCV co-infected patients with hepatocellular carcinoma: The CARCINOVIC Cohort.

HIV/HCV co-infected patients with hepatocellular carcinoma (HCC) have poorer survival than HCV mono-infected patients. We aimed to evaluate the prognostic factors for survival. From 2006 to 2013, 55 incident HCCs among HIV+/HCV+ patients, from three ANRS cohorts, were compared with 181 HCCs in HIV-/HCV+ patients from the ANRS Cirvir cohort. HIV+/HCV+ patients were younger (50years [IQR: 47-53] vs 62 [54-70], P<0.001), male (89% vs 63%, P<0.001) than HIV-/HCV+ patients. At HCC diagnosis, both groups had a majority of non-responders to anti-HCV-therapy, and HIV+/HCV+ patients had more frequently known a previous cirrhosis decompensation (31% vs 14%, P=0.005). At diagnostic imaging, there were more infiltrative forms of HCC in HIV+/HCV+ group (24% vs 14%, P<0.001), associated with tumour portal thrombosis in 29%. During a median follow-up period of 11.96 [5.51-27] months since HCC diagnosis, a majority of palliative treatments were decided in HIV+/HCV+ patients (51% vs 19%, P<0.001). The 1 and 2-year crude survival rates were 61% versus 78% and 47% versus 63%, P=0.003 respectively. In a Cox model multivariate analysis adjusted for the cohort, age and sex, the most important prognostic factor for survival was the infiltrative form of the tumour (aRR: 8.10 [4.17-15.75], P<0.001). The radiological aggressiveness of the tumour is the best prognostic factor associated with poorer survival of HCC in HIV+/HCV+ patients. High α-foetoprotein level and decompensated cirrhosis are other ones. This justifies a particular attention to the detection and the management of small nodules in this high-risk population.

Marital Status and Survival of Patients with Hormone Receptor-Positive Male Breast Cancer: A Surveillance, Epidemiology, and End Results (SEER) Population-Based Study.

BackgroundAlthough marital status has been reported as a prognostic factor in different cancer types, its prognostic effect on hormone receptor (HR) positive male breast cancer (MBC) is unclear. The objective of the present analysis was to assess the effects of marital status on survival in patients with HR positive MBC.Material/MethodsPatients diagnosed with HR positive MBC from 1990 to 2014 in the Surveillance, Epidemiology, and End Results (SEER) database were included. Kaplan-Meier survival analysis and Cox proportional hazard regression were used to identify the effects of marital status on cancer-specific survival (CSS) and overall survival (OS).ResultsA total of 3612 cases were identified in this study. Married patients had better 5-year CSS and 5-year OS than unmarried men. In multivariate Cox regression models, unmarried patients also showed higher mortality risk for both CSS and OS, independent of age, race, grade, stage, PR status, HER2 status, and surgery. Subgroup survival analysis according to different ER/PR status showed that married patients had beneficial CSS results only in ER+/PR+ subtype, and CSS in the married and unmarried groups did not significantly differ by TNM stage. The results were further confirmed in the 1: 1 matched group.ConclusionsMarital status was an important prognostic factor for survival in patients with HR positive MBC. Unmarried patients are at greater risk of death compared with married groups. The survival benefit for married patients remained even after adjustment, which indicates the importance of spousal support in MBC.

Prognostic factors in patients with metastatic spinal cord compression secondary to melanoma: a systematic review.

Melanoma is one of the most common primary tumours associated with metastatic spinal cord compression (MSCC). The aim of this review is to identify prognostic factors specifically for MSCC secondary to melanoma. A systematic search of literature was performed in MEDLINE, Embase and the Cochrane Library to identify studies reporting prognostic factors for patients with MSCC secondary to melanoma. Two studies, involving a total of 39 patients, fulfilled the inclusion criteria. The variables associated with increased survival were receiving postoperative radiotherapy, receiving chemotherapy, perioperative lactate dehydrogenase level less than or equal to 8.0 µkat/l, preoperative haemoglobin level more than 11.5 mg/dl, an interval of 4 or more years between melanoma diagnosis and skeletal metastasis, absence of further skeletal metastases, absence of visceral metastases, Eastern Cooperative Oncology Group Performance Status of 2 or less, two or fewer involved vertebrae, being ambulatory preradiotherapy and an interval of more than 7 days between developing motor deficits and radiotherapy. The variables associated with good functional outcome were slow development of motor dysfunction, good performance status and being ambulatory before radiotherapy. The most important prognostic factors for survival are Eastern Cooperative Oncology Group Performance Status of 2 or less and absence of visceral metastases. There is a lack of studies looking specifically at prognostic factors for patients with MSCC secondary to melanoma, and the number of patients involved in the existing studies is small.

Radicalness and complications of repeated surgery for malignant neuroepithelial tumors of the posterior cranial fossa in children

The study objective was to assess the resection extent of recurrent malignant neuroepithelial tumors of the PCF in children as well as the risk and structure of postoperative complications. The prospective study included 50 patients under the age of 18 who underwent surgery for recurrent malignant neuroepithelial tumors of the PCF at the Neurosurgical Institute (NSI) in the period between 2002 and June 2015. Anaplastic ependymomas were present in 37 patients, and medulloblastomas were detected in 13 patients. A total of 58 repeated surgeries were performed. GTR was achieved in 53 (91.4%) cases, near total resection (NTR) was achieved in 2 (3.4%) cases, and subtotal resection (STR) was achieved in 3 (5.2%) cases. The mean bed-day after surgery was 12 (4-47) days, and the mean critical care stay was 3.2 (0-23) days. Seven patients required tracheostomy; meningitis developed in 3 patients; liquorrhea occurred in 2 cases. Ventriculoperitoneal shunting was used in 8 (13.8%) cases. One (1.7%) patient died in the early postoperative period. Our results demonstrate that resection of recurrent malignant neuroepithelial tumors in children can be performed with high radicalness (90%) and acceptable risks.

MTOR PATHWAY PROTEIN IMMUNOEXPRESSION AS A PROGNOSTIC FACTOR FOR SURVIVAL IN HNC: A SYSTEMATIC REVIEW AND META-ANALYSIS

Activated proteins in the mTOR pathway are deregulated in multiple types of cancer. These proteins may be important targets for anticancer therapy. The aim of this study was to summarize existing cohort studies to determine whether immunoexpression of mTOR pathway proteins are important prognostic factors for survival in head and neck cancer (HNC) patients. A systematic review was performed using the Cochrane, Lilacs, PubMed, ScienceDirect, Scopus and Web of Science databases (up to 23 January 2015). A meta-analysis was conducted to measure the frequency of protein expression in HNC patient samples and the prognostic value of mTOR pathway proteins for overall survival (OS) and disease-free survival (DFS). 12 studies were included in the final analysis. The meta-analysis revealed that the frequency of overall expression of mTOR pathway proteins was 74.42% (CI: 63.3 to 84.0, P < 0,001, n=2,016 samples). The survival meta-analysis showed a pooled hazard ratio for OS and DFS of 1.44 (95% confidence interval [95% CI] 1.14-1.73) and 1.18 (95% CI 0.71-1.64), respectively. This systematic review and meta-analysis support evidence that mTOR pathway proteins can be used as predictive markers for survival in HNC patients because their expression was significantly associated with poor OS and short DFS.

The influence of marital status on survival in patients with oral tongue squamous cell carcinoma.

Marital status was found to be an independent prognostic factor for survival in several cancers. However related researches of oral tongue squamous cell carcinoma (OTSCC) are still rare. We explored the Surveillance, Epidemiology, and End Results (SEER) program and finally identified 14,194 patients with OTSCC. Kaplan-Meier analysis and multivariate Cox regression models were used to distinguish risk factors for overall survival (OS) and tumor cause-specific survival (TCSS). Widowed patients had the highest percentage of female, highest average ages and more prevalence with localized SEER Stage significantly, while patients in the single group were younger than other groups. After univariate analysis and multivariate analysis, marital status was demonstrated to be an independent prognostic factor of OS and TCSS. Married patients showed better 5-year OS (65.6%) and 5-year TCSS (89.9%) than other patients. Subgroup survival analysis according to AJCC TNM stage and SEER stage showed that the widowed patients demonstrated worst OS and TCSS compared to other groups. Marital status was an important prognostic factor for survival in patients with OTSCC. Widowed patients exhibited with the highest risk of death compared with other groups.

Analysis of lymphocyte-neutrophil relationship in patients with advanced kidney cancer and the response to one-line treatment with target therapies.

e23034 Background: In kidney cancer, some important prognostic factors of survival are known and inflammation plays a key role. It has been proven that cancer progress is not only determined by the characteristics of the tumor but also by the response of the host. It is known that a high RNL has been identified as an independent prognostic factor associated to poor survival in several/different types of cancer, including breast cancer, colon cancer, gastric cancer, mesothelioma and pancreas. The primary aim was to evaluate if RNL can be used as a prognostic indicator of SLP in patients with advanced CCR with 1st line treatment with tirosin-kinasa inhibitors. The secondary aim was to evaluate whether there was a relationship between prognostic factors, smoking habits, BMI, anemia, calcemia, KPS and nephrectomized patients as opposed to those who were not operated with RNL and SLP. Methods: Retrospective and analytical study. The medical histories from patients with metastatic kidney cancer diagnosis were analyzed as well as those who were undergoing treatment with Sunitinib and Pazopanib. The cut value of &gt; ó &lt; 3 was taken as a reference point for RNL. Overall survival analysis will be evaluated through the Kaplan-Meier curve and the meaning will be verified by the log-rank test. The multivariate analysis will be done through the Chi-square test. Results: A total of 65 patients were included in this study. 50 patients (75.38%) received treatment with Sunitinib and 15 patients (24.62%) with Pazopanib. It was observed that RNL &lt; 3 was correlated with a higher SLP 21,6 months vs 8.9 months, p = 0,00002 and it was statistically significant. In subgroup analysis, those patients with normal values of corrected calcium the survival was 20 months vs 12, 2 months (p: 0.01), non-smokers 21 months vs 12 months (p: 0.05), KPS &gt; 1 17,72 months Vs 8,8 months (p: 0.03) and a RNL &lt; 3 showed a higher survival in a statistically significant way. There were no differences in survival when we performed the anemia analysis, BMI, smoking habits and KPS 0 to 1. Conclusions: We can conclude that those patients with RNL &lt; 3 and who had already undergone treatment with ITK revealed a better SLP in a statistically significant way.

Comparison of cancer stage distribution in the immigrant and host populations of Norway, 1990-2014.

Cancer stage at diagnosis is the most important prognostic factor for survival. We conducted a nationwide, population-based cohort study to investigate cancer stage distribution in immigrants compared to the host population of Norway. All patients recorded in the Cancer Registry of Norway in 1990-2014 were included (17,709 immigrants and 431,936 Norwegians). Individual level sociodemographic data was obtained from Statistics Norway. Ordered logistic regression was used to estimate if immigrants were diagnosed with cancer at a more advanced stage than Norwegians. Seven cancer sites were analyzed (breast, cervix, colorectal, liver, lung and trachea, prostate and stomach). With exception of breast cancer, we did not observe a clear pattern of more advanced cancer stage distribution in immigrants compared to Norwegians. Odds ratios and corresponding 95% confidence intervals for being diagnosed with a more advanced stage of breast cancer for non-Western immigrant groups compared to Norwegians were: Eastern Europe: 1.41 (1.20-1.65), Middle East: 1.58 (1.19-2.10), sub-Saharan Africa: 1.44 (0.99-2.08), South Asia: 1.40 (1.07-1.83) and East Asia: 0.90 (0.72-1.13). Sub-analyses showed that late detection of breast cancer in young non-Western immigrants might be of particular concern. Young (<50 years) non-Western immigrants had an odds ratio of 1.40 (1.21-1.62) for more advanced stage breast cancer compared to young Norwegians.